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Bovolenta TM, Schumacher-Schuh AF, Santos-Lobato BLD, Godeiro Júnior CDO, Silva DJD, Nicaretta D, Barbosa ER, Cardoso FEC, Della Coletta MV, Braga Neto P, Cury RG, Tumas V, Felicio AC. Average annual cost of Parkinson's disease in a Brazilian multiethnic population. Parkinsonism Relat Disord 2023; 117:105897. [PMID: 37931350 DOI: 10.1016/j.parkreldis.2023.105897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION With the current demographic transition, it is estimated that by 2050 Brazil will have a population of 90 million people aged 60 years or more, and in parallel Parkinson's disease (PD) will bring a considerable economic burden to our society. Brazil is considered multiracial due to its colonization, generating important social and regional inequalities. Knowing the costs of the PD may aid to improve local public policies. However, in Brazil, no estimates of these values have been made so far. OBJECTIVES To evaluate direct, indirect, and out-of-pocket costs in Brazilian people with PD (PwP). METHODS Categorical and numerical data were collected through a customized and standardized cost-related-questionnaire from 1055 PwP nationwide, from 10 tertiary movement disorders centers across all Brazilian regions. RESULTS The estimated average annual cost of PwP was US$ 4020.48. Direct and indirect costs accounted for 63% and 36% of the total, respectively, and out-of-pocket costs were 49%. There were no evidence of differences in the total cost of PD across the regions of the country; however, differences were reported between the stages of the Hoehn and Yahr scale (H&Y). CONCLUSION This data suggests a considerable burden of PD for Brazilian society in general, not only for the public health system, but mainly for those with PD.
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Affiliation(s)
| | | | | | | | - Delson José da Silva
- Neuroscience Core, Hospital Clinics, Federal University of Goiás, Brazil Integrated Neurosciences Institute, Goiás, Brazil.
| | - Denise Nicaretta
- School of Medicine and Surgery - UNIRIO HUGG/EBSERH Rio de Janeiro, Brazil.
| | - Egberto R Barbosa
- Movement Disorders Clinic, Department of Neurology, School of Medicine of the University of São Paulo, São Paulo, SP, Brazil.
| | - Francisco E C Cardoso
- Movement Disorders Unit Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | | | - Pedro Braga Neto
- Department of Clinical Medicine, Neurology Section, Federal University of Ceará, Ceará, Brazil.
| | - Rubens G Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Vitor Tumas
- Department of Neuroscience and Sciences of Behavior, Division of Neurology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
| | - Andre C Felicio
- Department of Neurology and Brain Institute, Hospital Israelita Albert Einstein, São Paulo, Brazil.
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Arjona M, Toldo JMP, Queiroz NC, Pedroso JL, Neto GDCC, Barsottini OGP, Felicio AC. A Real-World Study of Cerebral 99mTc-TRODAT-1 Single-Photon Emission Computed Tomography (SPECT) Imaging of the Dopamine Transporter in Patients with Parkinson Disease from a Tertiary Hospital in Brazil. Med Sci Monit 2020; 26:e925130. [PMID: 33361743 PMCID: PMC7768796 DOI: 10.12659/msm.925130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Studies on the routine clinical use of dopamine transporter (DAT) imaging have largely been conducted in Europe and the United States. In this real-world study, we investigated the use of cerebral 99mTc-TRODAT-1 SPECT imaging of DAT in patients with Parkinson disease (PD) at a tertiary hospital in Brazil. Material/Methods We included 119 patients with suspected PD or clinically unclear parkinsonism who underwent brain scintigraphy with 99mTc-TRODAT-1 during a 3-year period. Additionally, a brief interview was conducted with the physician who requested the scan to determine the usefulness of the method in clinical decision-making. Results Regarding the scan requests, most were intended to evaluate or confirm dopaminergic denervation (69%), distinguish PD from essential tremor (10%), or distinguish degenerative parkinsonism from drug-induced parkinsonism (6%). Data analysis showed that scintigraphy with 99mTc-TRODAT-1 was useful in 85% of cases, changing the management of 75% of the patients who underwent a scan. The majority of physicians who requested the scan were neurologists, and 54% were self-reported movement disorder specialists. An inappropriate use of DAT imaging was seen in 5% of cases. Conclusions This study demonstrated that brain scintigraphy with the DAT ligand 99mTc-TRODAT-1 may influence diagnostic or therapeutic interventions, meaning that Brazilian physicians who requested the exam have taken in vivo DAT results into account at the time of clinical decision-making.
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Affiliation(s)
- Michelly Arjona
- Brain Institute, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Juliana M P Toldo
- Brain Institute, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Jose Luiz Pedroso
- Ataxias Ambulatory, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Andre C Felicio
- Brain Institute, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Fu JF, Matarazzo M, McKenzie J, Neilson N, Vafai N, Dinelle K, Felicio AC, McKeown MJ, Stoessl AJ, Sossi V. Serotonergic System Impacts Levodopa Response in Early Parkinson's and Future Risk of Dyskinesia. Mov Disord 2020; 36:389-397. [PMID: 33090574 DOI: 10.1002/mds.28340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/31/2020] [Accepted: 10/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The serotonergic system is known to contribute to levodopa-derived dopamine release in advanced Parkinson's disease. OBJECTIVE We investigated the role of the serotonergic system in determining response to treatment in early disease and risk for complications concurrently with dopaminergic alterations. METHODS Eighteen patients with early and stable Parkinson's disease underwent multitracer positron emission tomography using [11 C]dihydrotetrabenazine (vesicular monoamine transporter 2 marker), [11 C]methylphenidate (dopamine transporter marker), [11 C]-3-amino-4-(2-dimethylaminomethylphenylsulfanyl)-benzonitrile (DASB, serotonin transporter marker), and [11 C]raclopride (D2 marker) to investigate relationships between striatal dopaminergic and serotonergic alterations and levodopa-induced dopamine release, related to motor response to treatment and risk for dyskinesias, using a novel joint pattern analysis. RESULTS The joint pattern analysis revealed correlated spatial patterns conceptually related to abnormal dopamine turnover in the putamen (higher dopamine release associated with dopaminergic and serotonergic denervation); response to treatment significantly inversely correlated with turnover-related dopamine release (P < 10-5 ). Patterns identified without inclusion of the DASB data showed no correlation with clinical data, indicating an important contribution from the serotonergic system to a clinically relevant abnormal dopamine release in early disease. Subjects who experienced dyskinesia 3 years after baseline scans showed higher turnover-related dopamine release compared with subjects who remained stable (P < 0.01). CONCLUSIONS Joint analysis of dopaminergic and serotonergic data identified a turnover-related dopamine release component, strongly related to motor response to levodopa in early disease and contributing to higher risk for dyskinesia. These findings suggest that the contribution of the serotonergic system to dopamine release not only increases the risk for motor complications but also fails to provide sustained therapeutic advantage in early disease. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jessie F Fu
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michele Matarazzo
- Djavad Mowafaghian Centre for Brain Health, Pacific Parkinson's Research Centre, University of British Columbia & Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Jessamyn McKenzie
- Djavad Mowafaghian Centre for Brain Health, Pacific Parkinson's Research Centre, University of British Columbia & Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Nicole Neilson
- Djavad Mowafaghian Centre for Brain Health, Pacific Parkinson's Research Centre, University of British Columbia & Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Nasim Vafai
- Djavad Mowafaghian Centre for Brain Health, Pacific Parkinson's Research Centre, University of British Columbia & Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Katie Dinelle
- Djavad Mowafaghian Centre for Brain Health, Pacific Parkinson's Research Centre, University of British Columbia & Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Andre C Felicio
- Department of Neurology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Martin J McKeown
- Djavad Mowafaghian Centre for Brain Health, Pacific Parkinson's Research Centre, University of British Columbia & Vancouver Coastal Health, Vancouver, British Columbia, Canada.,Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Jon Stoessl
- Djavad Mowafaghian Centre for Brain Health, Pacific Parkinson's Research Centre, University of British Columbia & Vancouver Coastal Health, Vancouver, British Columbia, Canada.,Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vesna Sossi
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Pacific Parkinson's Research Centre, University of British Columbia & Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Vitor T, Kozasa EH, Bressan RA, Lacerda SS, Campos Neto GC, Batista IR, Gebrim LH, Cohen L, Amaro E, Felicio AC. Impaired brain dopamine transporter in chemobrain patients submitted to brain SPECT imaging using the technetium-99m labeled tracer TRODAT-1. Ann Nucl Med 2019; 33:269-279. [DOI: 10.1007/s12149-019-01331-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/06/2019] [Indexed: 12/15/2022]
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Bovolenta TM, de Azevedo Silva SMC, Saba RA, Borges V, Ferraz HB, Felicio AC. Average annual cost of Parkinson's disease in São Paulo, Brazil, with a focus on disease-related motor symptoms. Clin Interv Aging 2017; 12:2095-2108. [PMID: 29276379 PMCID: PMC5734235 DOI: 10.2147/cia.s151919] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Although Parkinson's disease is the second most prevalent neurodegenerative disease worldwide, its cost in Brazil - South America's largest country - is unknown. Objective The goal of this study was to calculate the average annual cost of Parkinson's disease in the city of São Paulo (Brazil), with a focus on disease-related motor symptoms. Subjects and methods This was a retrospective, cross-sectional analysis using a bottom-up approach (ie, from the society's perspective). Patients (N=260) at two tertiary public health centers, who were residents of the São Paulo metropolitan area, completed standardized questionnaires regarding their disease-related expenses. We used simple and multiple generalized linear models to assess the correlations between total cost and patient-related, as well as disease-related variables. Results The total average annual cost of Parkinson's disease was estimated at US$5,853.50 per person, including US$3,172.00 in direct costs (medical and nonmedical) and US$2,681.50 in indirect costs. Costs were directly correlated with disease severity (including the degree of motor symptoms), patients' age, and time since disease onset. Conclusion In this study, we determined the cost of Parkinson's disease in Brazil and observed that disease-related motor symptoms are a significant component of the costs incurred on the public health system, patients, and society in general.
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Affiliation(s)
| | | | - Roberta Arb Saba
- Neurology Department, Federal University of São Paulo, UNIFESP, São Paulo, Brazil
| | - Vanderci Borges
- Neurology Department, Federal University of São Paulo, UNIFESP, São Paulo
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Abstract
Brazil is currently experiencing a significant demographic transition characterized by a decrease in fertility rates and an exponential increase in the number of elderly citizens, which presents a special challenge for the health care professionals. More than other portions of the population, the elderly are most commonly affected by chronic diseases such as Parkinson’s disease. Policymakers contend that Brazil is reasonably well-prepared regarding elderly health care, with policies that aim to ensure the quality of life and the well-being of this portion of the population. However, what happens in practice falls short of what the Brazilian Constitution sets forth. Specifically, there is a clear contradiction between what the law recognizes as being a citizen’s rights and the implementation of guidelines. Because health financing in Brazil remains relatively low, the civil society tries to fill in the gaps as much as possible in the treatment of elderly patients suffering from chronic diseases such as Parkinson’s disease. In this review, we outline the current legislation in Brazil regarding the elderly and in particular, patients with Parkinson’s disease, in the context of a rapidly aging population.
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Affiliation(s)
- Tânia M Bovolenta
- R. Neurology Program, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Andre C Felicio
- R. Neurology Program, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Felicio AC. Commentary. J Neurosci Rural Pract 2017; 8:127-128. [PMID: 28149098 PMCID: PMC5225696 DOI: 10.4103/0976-3147.193566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Andre C. Felicio
- Department of Neurology and Brain Institute, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Bor-Seng-Shu E, Felicio AC, Braga-Neto P, Batista IR, Paiva WS, de Andrade DC, Teixeira MJ, de Andrade LAF, Barsottini OGP, Shih MC, Bressan RA, Ferraz HB. Dopamine transporter imaging using 99mTc-TRODAT-1 SPECT in Parkinson's disease. Med Sci Monit 2014; 20:1413-8. [PMID: 25109468 PMCID: PMC4138066 DOI: 10.12659/msm.890522] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Although the decrease in striatal dopamine transporter (DAT) density has been described in North American, European, and Asian Parkinson’s disease (PD) patients, studies on this issue are required in the rest of the world. This study examined the diagnostic utility of DAT imaging in Brazilian PD patients. Material/Methods Twenty PD patients (13 males, 7 females, median age: 62 years, median age at disease onset: 56 years, median disease duration: 5 years, and median UPDRS-III score: 29) and 9 age- and sex-matched healthy subjects underwent single-photon emission computerized tomography (SPECT) using 99mTc-TRODAT-1. Results PD patients showed a significant decrease in the striatum, caudate nucleus, and putamen DAT densities compared with data from healthy subjects. Striatal 99mTc-TRODAT-1 bindings had the highest diagnostic accuracy compared to those estimates from caudate nucleus and putamen. For the diagnosis of PD, a striatal 99mTc-TRODAT-1 binding cut-off value of 0.90 was associated with a sensitivity of 100% and a specificity of 89%. There was no significant difference between striatal 99mTc-TRODAT-1 binding values provided by different readers, contrary to 99mTc-TRODAT-1 binding estimates in the caudate nucleus. Conclusions Striatal DAT imaging using 99mTc-TRODAT-1 can be considered a marker for differentiating PD patients from healthy individuals, with a good interobserver reproducibility.
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Affiliation(s)
- Edson Bor-Seng-Shu
- Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Andre C Felicio
- Departments of Neurology and Neurosurgery, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Pedro Braga-Neto
- Department of Neurology and Neurosurgery, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Ilza Rosa Batista
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Wellingson Silva Paiva
- Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | | | | | - Ming Chi Shih
- Department of Neurology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Rodrigo A Bressan
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
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Felicio AC, Dinelle K, Agarwal PA, McKenzie J, Heffernan N, Road JD, Appel-Cresswell S, Wszolek ZK, Farrer MJ, Schulzer M, Sossi V, Stoessl AJ. In vivo dopaminergic and serotonergic dysfunction in DCTN1 gene mutation carriers. Mov Disord 2014; 29:1197-201. [PMID: 24797316 DOI: 10.1002/mds.25893] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 03/10/2014] [Accepted: 03/25/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION We used positron emission tomography (PET) to assess dopaminergic and serotonergic terminal density in three subjects carrying a mutation in the DCT1 gene, two clinically affected with Perry syndrome. METHODS All subjects had brain imaging using 18F-6-fluoro-l-dopa (FDOPA, dopamine synthesis and storage), (+)-11C-dihydrotetrabenazine (DTBZ, vesicular monoamine transporter type 2), and 11C-raclopride (RAC, dopamine D2/D3 receptors). One subject also underwent PET with 11C-3-amino-4-(2-dimethylaminomethyl-phenylsulfanyl)-benzonitrile (DASB, serotonin transporter). RESULTS FDOPA-PET and DTBZ-PET in the affected individuals showed a reduction of striatal tracer uptake. Also, RAC-PET showed higher uptake in these area. DASB-PET showed significant uptake changes in left orbitofrontal cortex, bilateral anterior insula, left dorsolateral prefrontal cortex, left orbitofrontal cortex, left posterior cingulate cortex, left caudate, and left ventral striatum. CONCLUSIONS Our data showed evidence of both striatal dopaminergic and widespread cortical/subcortical serotonergic dysfunctions in individuals carrying a mutation in the DCTN1 gene.
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Affiliation(s)
- Andre C Felicio
- Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, BC, Canada
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Bor-Seng-Shu E, Pedroso JL, Felicio AC, Ciampi de Andrade D, Teixeira MJ, Braga-Neto P, Batista IR, Barsottini OGP, Borges V, Ferraz HB, Shih MC, Bressan RA, de Andrade LAF, Walter U. Substantia nigra echogenicity and imaging of striatal dopamine transporters in Parkinson's disease: A cross-sectional study. Parkinsonism Relat Disord 2014; 20:477-81. [DOI: 10.1016/j.parkreldis.2014.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 01/03/2014] [Accepted: 01/11/2014] [Indexed: 10/25/2022]
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Chang CV, Conde SJ, Luvizotto RAM, Nunes VS, Bonates MC, Felicio AC, Lindsey SC, Moraes FH, Tagliarini JV, Mazeto GMFS, Kopp P, Nogueira CR. Oncogenic osteomalacia: loss of hypophosphatemia might be the key to avoid misdiagnosis. ACTA ACUST UNITED AC 2013; 56:570-3. [PMID: 23295300 DOI: 10.1590/s0004-27302012000800018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 10/26/2012] [Indexed: 11/21/2022]
Abstract
Diagnosing oncogenic osteomalacia is still a challenge. The disorder is characterized by osteomalacia caused by renal phosphate wasting and low serum concentration of 1,25-dihydroxyvitamin D3 occurring in the presence of a tumor that produces high levels of fibroblast growth factor 23. However, it is possible that the disease is much more misdiagnosed than rare. We present the case of a 42-year-old man with a long-term history of undiagnosed progressive muscle weakness. His laboratory results mainly showed low serum phosphate. Surgical removal of a nasal hemangiopericytoma that had been diagnosed five years earlier, brought him to a symptom-free condition. Even though knowing the underlying etiology would explain his osteomalacia, the patient sought medical help from countless physicians for five consecutive years, and only after adequate treatment a rewarding outcome was achieved.
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Affiliation(s)
- Claudia V Chang
- Department of Medicine, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo, Botucatu, SP, Brazil.
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Braga-Neto P, Felicio AC, Hoexter MQ, Pedroso JL, Dutra LA, Alessi H, Minett T, Santos-Galduroz RF, da Rocha AJ, Garcia LA, Bertolucci PHF, Bressan RA, Barsottini OGP. Cognitive and olfactory deficits in Machado–Joseph disease: A dopamine transporter study. Parkinsonism Relat Disord 2012; 18:854-8. [DOI: 10.1016/j.parkreldis.2012.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 02/22/2012] [Accepted: 04/11/2012] [Indexed: 10/28/2022]
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Pedroso JL, Bor-Seng-Shu E, Felicio AC, Braga-Neto P, Dutra LA, de Aquino CC, Ferraz HB, do Prado GF, Teixeira MJ, Barsottini OG. Severity of restless legs syndrome is inversely correlated with echogenicity of the substantia nigra in different neurodegenerative movement disorders. a preliminary observation. J Neurol Sci 2012; 319:59-62. [PMID: 22632781 DOI: 10.1016/j.jns.2012.05.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 05/04/2012] [Accepted: 05/04/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Hyperechogenicity of the substantia nigra is a frequent observation on transcranial sonography in Parkinson's disease and Machado-Joseph disease patients. Additionally, restless legs syndrome is a sleep disorder that is also frequently found in both diseases. Autopsy studies have demonstrated increased SN iron content in hyperechogenic substantia nigra. Iron storage is also known to be involved in restless legs syndrome. We formally compared echogenicity of the substantia nigra with restless legs syndrome in Parkinson's disease and Machado-Joseph disease patients. METHODS Transcranial brain sonography was performed in a sample of Parkinson's disease and Machado-Joseph disease patients, and findings then correlated with the presence and severity of restless legs syndrome. RESULTS There was a continuum of substantia nigra echogenicity among groups (Parkinson's disease versus Machado-Joseph disease versus controls) and sub-groups (Parkinson's disease with and without restless legs syndrome versus Machado-Joseph disease with and without restless legs syndrome) as well as a statistically significant negative correlation between restless legs syndrome severity and substantia nigra echogenicity (p<0.001). CONCLUSIONS These preliminary observations demonstrate that the severity of RLS may be influenced by nigral iron load reflected by substantia nigra echogenicity in different neurodegenerative movement disorders.
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Affiliation(s)
- José Luiz Pedroso
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.
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Pedroso JL, Felicio AC, Braga-Neto P, Barsottini OG. Movement disorders in spinocerebellar ataxias. Mov Disord 2011; 26:2302. [DOI: 10.1002/mds.23928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 07/23/2011] [Accepted: 08/01/2011] [Indexed: 11/11/2022] Open
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Silveira-Moriyama L, Munhoz RP, de J. Carvalho M, Raskin S, Rogaeva E, de C. Aguiar P, Bressan RA, Felicio AC, Barsottini OG, Andrade LAF, Chien HF, Bonifati V, Barbosa ER, Teive HA, Lees AJ. Olfactory heterogeneity in LRRK2
related Parkinsonism. Mov Disord 2010; 25:2879-83. [DOI: 10.1002/mds.23325] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Felicio AC, Godeiro C, Moriyama TS, Laureano MR, Felix EPV, Borges V, Silva SMA, Ferraz HB. Speech-induced lingual dystonia. Arq Neuropsiquiatr 2010; 68:653-5. [PMID: 20730328 DOI: 10.1590/s0004-282x2010000400034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sica RE, Godeiro-Junior C, Oliveira ASB, Felicio AC, Chieia MA, Gabbai AA. Conjugal amyotrophic lateral sclerosis. Arq Neuropsiquiatr 2010; 68:323-324. [PMID: 20464312 DOI: 10.1590/s0004-282x2010000200036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Godeiro-Junior C, Felicio AC, Benites V, Chieia MA, Oliveira ASB. Late-onset hexosaminidase A deficiency mimicking primary lateral sclerosis. Arq Neuropsiquiatr 2010; 67:105-6. [PMID: 19330222 DOI: 10.1590/s0004-282x2009000100024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Clecio Godeiro-Junior
- Neuromuscular Disorders Unit, Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil.
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Felicio AC, Godeiro-Junior C, Shih MC, Borges V, Silva SMA, Aguiar PDC, Hoexter MQ, Barsottini OGP, Andrade LAF, Bressan RA, Ferraz HB. Evaluation of patients with Clinically Unclear Parkinsonian Syndromes submitted to brain SPECT imaging using the technetium-99m labeled tracer TRODAT-1. J Neurol Sci 2010; 291:64-8. [PMID: 20096859 DOI: 10.1016/j.jns.2009.12.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 10/15/2009] [Accepted: 12/22/2009] [Indexed: 10/19/2022]
Abstract
Despite its relatively high prevalence Parkinson's Disease (PD) is still misdiagnosed in approximately 25% of cases. In this study our aim was to evaluate patients with Clinically Unclear Parkinsonian Syndromes (CUPS) submitted to brain SPECT imaging using the technetium-99m labeled Dopamine Transporter (DAT) tracer TRODAT-1. We recruited 15 subjects with CUPS and matched them with 13 patients with probable PD and 13 healthy control subjects (HCS). A SPECT with TRODAT-1 was performed at the baseline evaluation and patients from the CUPS were followed-up for 2-years to ensure or not PD diagnosis ("gold-standard"). The mean+/-SD results from Right and Left striatum Binding Potential (BP) were, respectively, 1.08+/-0.20 and 1.04+/-0.16 in the HCS group, 0.47+/-0.16 and 0.53+/-0.17 in the PD group, and 0.68+/-0.11 and 0.84+/-0.17 in the CUPS group. The rate of disagreement between baseline SPECT in the CUPS group as compared to the "gold standard" diagnosis (clinical diagnosis of PD on follow-up) was of 20%. The sensitivity of the SPECT with TRODAT-1 was 100%, while specificity was 70%. In conclusion, our data provided further information about the role of the technetium-99m labeled tracer TRODAT-1 as a biomarker of DAT reduction that can also be used in the diagnosis of patients with CUPS.
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Affiliation(s)
- Andre C Felicio
- Department of Neurology and Neurosurgery, Movement Disorder Unit, Federal University of São Paulo, Sao Paulo, Brazil.
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Godeiro-Junior C, Oliveira AS, Felicio AC, Chieia MA, Gabbai AA. Conjugal amyotrophic lateral sclerosis in Brazil. Arq Neuro-Psiquiatr 2009; 67:1045-8. [DOI: 10.1590/s0004-282x2009000600015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Accepted: 08/05/2009] [Indexed: 11/22/2022]
Abstract
The origin of amyotrophic lateral sclerosis (ALS) remains unknown, although it seems to be multifactorial. The role of environmental factors has been frequently investigated and suspicion of its influence can be obtained when clusters of a rare disease are described. OBJECTIVE: To describe conjugal cases of ALS in Brazil. METHOD: We describe 2 couples in which both spouses were affected by ALS. Both couples had lived in southeast Brazil and were married for at least 20 years. RESULTS: There was a great variability in clinical presentation of ALS in our patients. In both couples the interval between disease onsets was short. No precise environmental factors could be identified at the origin of these conjugal cases. CONCLUSION: The occurrence of ALS in couples living in the same area may be epidemiologically important, but we cannot exclude that cases may be due to a chance association.
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Affiliation(s)
- Clecio Godeiro-Junior
- Federal University of São Paulo, Brazil; Federal University of Rio Grande do Norte, Brazil
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Godeiro-Junior C, Felicio AC, Aguiar PC, Borges V, Silva SMA, Ferraz HB. Head tremor in patients with cervical dystonia: different outcome? Arq Neuropsiquiatr 2009; 66:805-8. [PMID: 19099115 DOI: 10.1590/s0004-282x2008000600005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 09/19/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The association of cervical dystonia (CD) with other movement disorders have been already described, but data on clinical outcome regarding these patients are scant. The aim of this paper was to investigate whether patients with CD and head tremor (HT) would have a different outcome regarding to botulinum toxin type-A (BTX-A) treatment response and clinical and demographic parameters. METHOD We retrospectively evaluated 118 medical charts of patients with CD and divided them into two groups: with (HT+) and without (HT-) head tremor. We compared the following clinical and demographic parameters: age at onset, disease duration, progression of symptoms, etiology, familial history, presence of hand tremor. We also analyzed the response to BTX-A according to Tsui score in both groups. RESULTS The occurrence of head tremor in our sample was of 38.2%. The occurrence of postural hand tremor in the patients from the HT+ group was higher than in the HT- one (p=0.015) and if we compare BTX-A response in each group, we observe that patients with HT present a better outcome in a setting of longer follow-up. In HT+ group, Tsui score pre treatment was 10 (6-12.5) and after follow-up was 8 (5.5-10.5); p<0.001. In HT- group there was no significant difference 9 (7-12) in pre treatment and after follow-up; p=0.07. CONCLUSION According to our data it seems that head tremor may influence the clinical outcome or treatment response with BTX-A in patients with CD.
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Affiliation(s)
- Clecio Godeiro-Junior
- Movement Disorders Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo SP, Brazil.
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Chang CV, Felicio AC, Toscanini AC, Teixeira MJ, Cunha-Neto MBCD. Pituitary tumor apoplexy. Arq Neuro-Psiquiatr 2009; 67:328-33. [DOI: 10.1590/s0004-282x2009000200033] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 03/09/2009] [Indexed: 11/21/2022]
Abstract
Pituitary tumor apoplexy is a medical emergency due to acute infarction or hemorrhage in the pituitary gland. In this review, the authors discuss the sellar anatomy, the pituitary gland and adenomas' vascularization and the general aspects of the syndrome such as its ethiopatogenesis, predisposing factors, clinical features, treatment and prognosis.
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Felicio AC, Bichuetti DB, Marin LF, dos Santos WA, Godeiro-Junior C. Bilateral Horizontal Gaze Palsy with Unilateral Peripheral Facial Paralysis Caused by Pontine Tegmentum Infarction. J Stroke Cerebrovasc Dis 2009; 18:244-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2008.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 10/17/2008] [Accepted: 10/24/2008] [Indexed: 11/29/2022] Open
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Godeiro-Junior C, Felicio AC, Goldzveig J, Chieia MA, Schmidt B, Oliveira ASB. An amyotrophic lateral sclerosis mimicker: eosinophilic fasciitis. Arq Neuropsiquiatr 2008; 66:888-90. [PMID: 19099133 DOI: 10.1590/s0004-282x2008000600023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Clecio Godeiro-Junior
- Neuromuscular Disorders Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo SP, Brazil.
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Felicio AC, Chang CV, Godeiro-Junior C, Okoshi MP, Ferraz HB. Hemichorea-hemiballism as the first presentation of type 2 diabetes mellitus. Arq Neuro-Psiquiatr 2008; 66:249-50. [DOI: 10.1590/s0004-282x2008000200022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Hoexter MQ, Shih MC, Mendes DD, Godeiro-Junior C, Felicio AC, Fu YK, Tufik S, Bressan RA. Lower dopamine transporter density in an asymptomatic patient with Kleine-Levin syndrome. Acta Neurol Scand 2008; 117:370-3. [PMID: 18028505 DOI: 10.1111/j.1600-0404.2007.00942.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Kleine-Levin syndrome (KLS) is a rare disorder whose pathophysiological mechanisms remain unknown. PATIENTS AND METHODS To investigate dopamine abnormalities in KLS, a [99mTc]-TRODAT-1 single photon emission computerized tomography (SPECT) was performed in a patient with KLS during the asymptomatic period and compared with three matched healthy controls. RESULTS The patient had 14% lower striatal dopamine transporter binding potential (DAT-BP) compared to the mean DAT-BP of three healthy controls. CONCLUSION This study provides in vivo evidence for abnormalities in the DAT-BP, suggesting an involvement of the dopaminergic system in the pathophysiology of KLS.
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Affiliation(s)
- M Q Hoexter
- LiNC-Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de São Paulo, São Paulo, Brazil.
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Felicio AC, Godeiro-Junior C, Alberto LG, Pinto APM, Sallum JMF, Teive HG, Barsottini OGP. Familial Behr syndrome-like phenotype with autosomal dominant inheritance. Parkinsonism Relat Disord 2007; 14:370-2. [PMID: 17977780 DOI: 10.1016/j.parkreldis.2007.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 08/11/2007] [Accepted: 08/11/2007] [Indexed: 11/18/2022]
Abstract
Behr syndrome is an autosomal recessive disease characterized by early-onset ataxia, optic atrophy and other signs such as pyramidal tract dysfunction. Autosomal dominant inheritance has also been described. In this case report we present a family pedigree of patients with an inherited autosomal dominant Behr syndrome-like phenotype emphasizing their clinical and neuroimaging features.
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Affiliation(s)
- Andre C Felicio
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil.
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Shih MC, Felicio AC, de Oliveira Godeiro-Junior C, de Carvalho Aguiar P, de Andrade LAF, Ferraz HB, Bressan RA. Molecular imaging in hereditary forms of parkinsonism. Eur J Neurol 2007; 14:359-68. [PMID: 17388981 DOI: 10.1111/j.1468-1331.2007.01691.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The development of in vivo molecular imaging to evaluate the dopamine (DA) system with positron-emission tomography and single photon emission computed tomography has been of key importance on monitoring in vivo nigrostriatal neuronal loss in Parkinson's disease (PD), mostly through assessments of pre- and post-synaptic DA receptors. The discoveries of genes related to hereditary forms of parkinsonism (PARK1, PARK2, PARK6, PARK7 and PARK8) have increased our understanding either of distinct subtypes of clinical expression in PD or its etiology. This article revises current data on molecular neuroimaging of genetic forms of parkinsonism comparing and contrasting its main features with the classical sporadic forms. Awareness of the spectrum variance in the genotype and its respective PD phenotype are useful to distinguish different pathophysiological mechanisms of PD.
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Affiliation(s)
- M C Shih
- Laboratório Interdiciplinar de Neuroimagem e Cognição (LiNC), Universidade Federal de São Paulo, São Paulo, Brazil.
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